Factors associated with the recurrence of foot ulcers in Japanese patients with diabetes

Patients with diabetes are frequently complicated with diabetic foot ulcers (DFUs) which are vulnerable to recurrence after healing. We retrospectively surveyed the recurrence of foot ulcer and related factors in Japanese patients with DFUs.

Forty-two feet of 39 patients were initially recruited in this study. During the follow-up period, the recurrence of foot ulcers was observed in nine feet. Peak planter pressure (PPP) distribution on the affected side was measured at three pressure levels. Photographs of the plantar scar were superimposed on the high-pressure plantar area, and the concordance of both lesions was counted.

The recurrence of foot ulcer was significantly related to higher body weight, a history of discontinued or unused insole, the existence of scar at the sole concomitant with load, and longer observation period. The existence of scar was further selected as a significant predictive variable in multiple logistic regression analysis. Furthermore, the recurrence rate significantly increased in parallel with the increment of the concordance rate at 250 kPa or more level of pressure (P = 0.0199, odds ratio = 22.054).

For the prevention of the recurrence of foot ulcers, education on the continuous use of insole and adequate treatments of scar at the sole, concomitant with load especially in patients with higher body weight and longer observation period, is required. It is plausible that the concordance of PPP and scar lesions properly predicts the recurrences of foot ulcers, which may help to avoid unnecessary amputations in the future in Japanese patients with diabetes.